Understanding Mental Illness

Sun, January 16, 2011

An editorial in the Williamsburg Virginia Gazette in the 1760s commented briefly on the murder of an elderly woman by the son of one of her neighbors. The editorial writer described the young man as a lunatic and called on the Virginia legislature to protect the public from any future violence by building and maintaining asylums. The legislature created America's first lunatic asylum at Williamsburg in 1775. The editorial also helped concretize the publicly held assumption that mental illness is always associated with unpredictable danger and violence. That 18th century editorial has come to mind numerous times since the recent shootings in Arizona.

A decision will be made soon whether Jared Loughner will share a severe mental illness diagnosis with Whitman, Hinckley and Choi or the label of nihilist with the Oklahoma City bomber. The public reaction is understandably mixed. Throughout the nation, the personal expression of support and grief has been spiritually eloquent. Other responses have been anger, confusion and a desire for retribution. The assailant has been described as a lunatic with calls for the death sentence, life without parole, or placement in a mental hospital. Arizona Gov. Jan Brewer has issued a statement expressing her remorse. She understands these complicated issues from the standpoint of a parent of a severely mentally ill child. Her son was diagnosed with schizophrenia more thanw 20 years ago and has lived in a state mental hospital after a not guilty by reason of insanity defense in a case of sexual assault and kidnapping. However, Brewer has been forced to cut state funding for mental health services.

Many mental health professionals have reserved their judgment whether Loughner is severely mentally ill. Most, however, are clear about the complexity of predicting violence and eschew the public assumption that historically connected it to mental illness. The mentally ill are usually not as violent as the rest of the population.

There are other facts about mental illness to consider. Mental illness is ubiquitous throughout the world. Fully 25 percent of the U.S. population has a diagnosable mental illness at any given time; but, only 5 percent to 10 percent requires intense professional care. However, the majority of individuals with mental illnesses does not seek or accept help unless required by a court. Regrettably, unrecognized and untreated mental illness is common in the U.S. leading to major losses in productivity, absenteeism, academic achievement or healthy relationships. Families remain the primary caregivers, and their lives, too, tend to reflect the emotional status of their loved ones. Since 2001, admissions to state mental hospitals have increased by 21 percent, reversing a 50-year decline that briefly gave support to the idea that advancements in mental health sciences might result in their permanent closure.

We also know that persons with severe mental illness tend to die 25 years earlier than others of the same age. Of these deaths, the majority are from preventable medical causes that have gone unrecognized and poorly treated. But up to 40 percent of these early deaths are from suicide. Admittedly, some people with mental illness may resort to violence when they believe that someone has done them harm as appears to have been the case at Virginia Tech. In addition, the person may expect to die in the commission of a crime almost as a martyr or as punishment. In his writing, Loughner appears to have predicted and planned his own death.

So what are we to conclude? Mental illness can be difficult to identify and sometimes even more difficult to treat or prevent. Predicting when or if violence will occur is more difficult. Clearly, little can be done where the illness is neither recognized or when professional help is not sought, rejected or unavailable.

However, we must not repeat the 18th century policy of locking people away in institutions. Rather, we must increase our understanding that mental illness is a brain disease that responds well to some interventions. We must increase public understanding of these illnesses and the value of seeking and using early treatment and the new services in the community and the campus geared toward integrated care and recovery.

Davis is a professor and the Robert Lee Sutherland Chair in Mental Health and Social Work at UT.